Robert Sigal, MD – Special Interview!
Learn the challenges and successes of Robert Sigal, MD, as he shares his insight and expertise on all facets of running a partnership practice. Not to be missed!
Beauty and the Biz
Ep.38: Special Interview with Robert Sigal, MD
Catherine Maley, MBA: Hello and welcome to Beauty and the Biz where we talk about the marketing and business side of plastic surgery practices. I’m your host, Catherine Maley, author of Your Aesthetic Practice: What Your Patients Are Saying, as well as consultant to plastic surgery practices to get them more patients and more profit. Now, today’s a special day because I have an incredibly great guest. And I’m very excited about him because he really knows this game. Well. He’s been in the industry a long time and he’s going to give us a ton of value. And it’s Dr. Rob Sigal, he is the managing partner of a very successful plastic surgery practice called Austin Weston, the Center for cosmetic surgery. Now it’s located outside of Washington DC, in a town called Reston, Virginia. Now, this is the best part, there are four board certified plastic surgeon partners with over 75 years of combined experience. I believe it’s even the longest running plastic surgery practice in the area or the state or the region, I’ll ask Dr. Sigal to clear that up. But I have been there, it’s gorgeous. It’s got five fully equipped accredited operating suites on site, along with a med spa offering non-surgical treatments and they’ve also got an office manager, staff of patient coordinators, estheticians, nurse injector, laser texts, surgical techs and admin. So, I want to welcome Dr. Sigal to Beauty and the Biz.
Robert Sigal, MD: I am so delighted to be here talking to you. This is great.
Catherine Maley, MBA: Thank you so much. And you know, let’s just go ahead and start just tell me how did you get into plastic surgery? And how did you find your way over to Austin Weston?
Robert Sigal, MD: There’s always a story, isn’t there? Right? You know what? I trained for nine years in my surgical residency. And over the course of that period of time, I saw medicine change. This was back I got out of medical school in 85. So, I went out to LA did some general surgery. And then I came back to Philadelphia, I did some cancer research, and I finished my general surgery. And then I came back to Philadelphia and did my plastic surgery. And over that period of time, reimbursable medicines sort of went away and HMOs came off to the fore, I was going to be a cancer surgeon and academic cancer surgeon. But I knew what I learned during the cancer research. Because I wasn’t that smart. You know, and I wasn’t going to cure cancer. And I was going to struggle for grants. And I didn’t like writing grants. And frankly, I didn’t like the academic environment. I mean, yeah, I just, I didn’t like the politics of it. And so, it’s rough, right? I mean, and so you get to know yourself over a while. It’s actually one of the benefits of taking your time as you’re training. And I saw the plastic surgery option as a way to get outside of reimbursable medicine if I wanted to choose that route. And ultimately, at the end of my training, it seems the most palatable way to go. And I, Harvey Austin and George Weston, I was in Philadelphia, they were down in Reston, Virginia outside DC, like you said, they advertised plastic surgery news for the physician. And something that turns out George Weston had written was that we have put a wonderful staff that takes wonderful care of us and our patients unquote. And that line, I can’t believe I still remember I hadn’t thought of that line, honestly, in 30 years, 25 years, but it rang with me and it made me realize that I need to be taken care of coming out of my training, I was a very, I thought I thought overly so, dry. I really, I was okay as a surgeon, but I knew that I didn’t know how to run a business. And I needed help. And these guys were close enough to Philadelphia that I could visit my in-laws and bring my two little kids with me. But they weren’t so close that my in-laws could just drop you. Right. And so, I mean, when I was in Philly, that’s, it was great to have them do that. But you know, it was just seemed like the right place. And I thought, you know, DC was a really interesting place to be. And so, I came down, and I actually met with them. And they didn’t accept me and they said they said I was too academic, and that I didn’t have a never showed a real interest in cosmetic surgery. And I wrote them back. And I said I think you misjudged me. I never really had an opportunity to really dive into cosmetic surgery in my plastic surgery training. I was really about publishing papers and doing bench research, etc. So, they invited me back down and I remember Harvey saying I think this is one of the lessons which then take-home lessons from what we talked about today. That when people insist on being with you, listen and can Consider taking them. And it’s right. So, they just keep showing up those people that just won’t quit go away, you know, and I sort of was that and Harvey was attuned to it. And they hired me. And I’ve been there for 25 years since.
Catherine Maley, MBA: Well, you hire a contractor and associate, how did you position yourself?
Robert Sigal, MD: Yeah. So, we had– this is another important thing I think to take home is that we had a business advisor, a guy named [05:27] Jacques Ribault, who I’ve since turned on to other plastic surgeons, and he’s helped a number of them, structure their practices profitably and integrate personalities. What he designed was what he called easy and easy out. There, George and Harvey were partners at that point. And I came on the first year as a salaried employee. Second year, I was a salary, they raised my salary. And third year I was salary plus overage. In other words, I was going to take 25% of what I built for my salaries guaranteed, fourth year was the same thing, as was the fifth year. And after five years, I became partner. Now that money was that I was contributing above what I was taking home, was going into the practice, if you will, and the partners after paying the expenses, were taking it home, Harvey was getting what we called a premium payment. For the five years that I was doing that by him, if you will, and that premium payment is different than a buyout, probably didn’t go away. At the end of his payment of his premium payment, he stuck around So, for probably another seven, eight years. George had his premium payment A number of years ago, our qualifications are that you’ll be with us for 21 years, before you’re eligible for it. George got his premium payment. He’s still around, I got my premium payment. And I’m still around, I just finished and I just passed the presidency of the practice over to Dr. Poindexter. Important Dexter, who’s now the president and the director, Dr. Knotts finished his five year by him, and he is now a partner. So, there’s four partners, and Poindexter is getting a premium payment. And we have the rule that as the senior partner, getting a premium payment, you’d become the president of the practice and the presidency in our practice doesn’t mean that you make all the decisions. In fact, it’s very much a democracy, right? We sit down every Tuesday night, and we have it organized. By the Tuesday, the first Tuesday of the month is marketing. Second is business. Third is a staff meeting where you’re all we all get together over dinner, and your different topics, and forth at the moment is off. So, we all sit around on that second, all those meetings, really, during the course of the day, because we’re all in one building. And when issues come up, we’ll hash it out. If somebody feels really, really strongly about something I will defer. Nobody. And this is like another take home point, you got to take your ego out of business. And if you don’t, you’re in trouble. So that’s very hard for surgeons out there fairly significant egos, you know, and it’s really hard to not get like, here’s an example. Okay. Early on in my practice meditation, it was unhappy with her results. And you wonder money back. I didn’t do anything wrong. A certain result was okay. It wasn’t what she wanted, but she wanted her money back. And I was like, No, I’m not gonna give your money back. I it was a great result. I you know, so I went to shock the business guy, and he says, Give me your money back. And I said, What, what? Why would I do that? And as a result, is fine. He said, because it’s not worth it. Just move along. move on with your life. So, I asked the other really good businessman that I know my result, father-in-law, Philadelphia, and I described the situation he said, Give me the money back. And I’m like, wow, the two smartest businessman I know, to give her father-in-law money back, you know what I’m gonna listen to? And I gave her my I don’t remember this woman. I don’t know. I just remember this lesson. Okay. Over the course of the years, a given probably a half a dozen people their money back. It’s 25 years. I’ve been in practice. I’ve never been sued. I’ve been but there’s something going on. Now, Catherine, I know, you’re well aware of these things have changed significantly over the years. Now, the threat of writing something bad about you on the internet, is enough for me to consider it. You know, I mean, 25 years ago, you couldn’t do that. And you get a bad review. I mean, you got to think about it. It was getting sued. You know, and why do people get sued if people get sued because patients feel ignored and disrespected, and these things just dropped? made wrong? Don’t ever do that to patients, you know, and if they get a little bit of money back at the end of the day is nothing. It just isn’t. So anyway, where were we?
Catherine Maley, MBA: –was it? How many years ago did Austin Weston start that practice?
Robert Sigal, MD: So, Harvey started back in 1970. At that point, yeah. So, I’d say something. There’s a certain founder mentality that you got to have and if younger people are listening to this, you got to have If you’re going to be successful founder practice, and I call it the gene that doesn’t give a shit, what people say about you, right?
Catherine Maley, MBA: That is so true, you can’t care what other people are saying you have to stay focused.
Robert Sigal, MD: You got to be willing to do stuff that like– I wasn’t, you know, I just thought was about same shit right there. You know I’m just kind of like very self-aware and I’m concerned about what other people think about me Harvey couldn’t care less at once. So, this is this is back in the day, right? He left a practice in Pittsburgh, a successful practice of reconstructive and cosmetic in Pittsburgh to do a course called [inaudible 10:36].
Catherine Maley, MBA: Oh my god. Yes, I’m in Sausalito, the guy from [inaudible 10:42] lived on a sailboat out here and then developed this.
Robert Sigal, MD: [inaudible 10:47]. That wasn’t his name. He was like a day, car salesman or something outside Philly. But he has to get some pretty crazy insights. And I ended up doing some of the courses because Harvey thought they were important. And in fact, they were important. So that’s another lesson, your best things that you’re going to learn in life, you aren’t necessarily what you learned in your medical school or in your surgical training, as applicable to your practice medicine. Kirby came down here did us realize that he was really unhappy in his life up in Pittsburgh. And so, he left his practice. He gave all of his belongings to Jacques. Gentlemen, I knew that I mentioned before we actually met in essence, and I went driving across the country. Found himself one Christmas, weeping behind a dumpster as he tells it in Arizona, and he realized he was going to come back. And he was going to do just what he wanted. And so, all he wanted to do when cosmetic surgery in plastic surgery was cosmetic surgery. And so, he opened up his practice in 1978. In an apartment building, he ended up operating in the dining room with his with his wife as his receptionist. And the key when you first started is to keep expenses low. And he realized, so he went back to so he started teaching some of the seminars and has an opportunity to just get up in front of 100 people and say, Hi, my name is Harvey Austin. I’m a cosmetic surgeon in McLean, Virginia, consults for free, come on by now, this is what we’re going to talk about tonight. And he tells a story about you know, putting before and after books together. And at one point, going through a wedding, with his before and after books and showing them on the dance floor. Well, you know what, I could never do that. I have that gene that cares what people think about me, Harvey didn’t have–
Catherine Maley, MBA: Wait a second, [inaudible 12:37] aside for anybody, are you on YouTube yet? His daughter just got married. And he did the most amazing song with his own lyrics. That was amazing. Like it was a TV grade amazing.
Robert Sigal, MD: I can’t believe you saw that.
Catherine Maley, MBA: Oh, my God, I love it. Is that on YouTube?
Robert Sigal, MD: I’m not sure yet, it will at some point. Well, I think this just happened, Catherine, so we have like videos from the crowd. But what we don’t have is like the professional video, which we’re going to put up on an Austin Weston site. But I may put this one up and put the other one as well. But you know, honestly, I want to tell you something, but it’s all part of that. Right? Like I being rehearsed that 50 times I, you know, was concerned about what I wrote, it had to be perfect and had to make me Reaper, I didn’t even include it, you know, so Harvey wouldn’t care who’s got it, he would have gotten up and risked about it and said, I’m a cosmetic surgeon and you know, consults are still free. You know, I’m not about to do that. Anyway. But so that founders Dean, it was really important. And one of the, I know people are interested in marketing that are listening to this, but recognize whether you have that gene or not. And if you don’t consider partnering with someone who you recognize has it. But one of the coolest things besides that early marketing at no cost, a really little cost that I remember doing was that was part of the marketing, right? That’s another thing we do is we let the youngest guy do the marketing, if they have any talent for it, because it allows them some sense of control of the practice, which is important. And it gives them some significant responsibility for everyone’s wellbeing. And that sort of inculcates that team spirit, if you will. But I remember I, Harvey ended up writing an article about different aspects of cosmetic surgery. And he was the first person to advertise in the Washingtonian magazine, which every big city has their equivalent, you know, that glossy magazine and, and that’s when he started doing it was generating an 11 to one return, you know. So, we, you know, that was back in the day, but nobody was doing and but that took a certain amount of not caring, you know, what people said about you? And, you know, all of this was great. I just remembered this. You know, how he got to the point where he didn’t care what his colleagues thought about him. This is something from us. He learned that recreation leads to disappearance. In other words, the more you go over something that has pain for you, the less hold it has on you and he showed me at his house. One time I came over for dinner, a notebook where he had written down, like, my colleagues will laugh at me. And he filled that notebook with it. And by the time by the time, he got to the end of that, he didn’t care anymore. And he advertised in the Washingtonian magazine. Now, whether it’s good or bad, we can talk about but it’s an interesting technique, you know, you’re concerned about Oh, he was he was the he was very successful. He had the largest practice cosmetic surgery; it was pretty impressive. What the graph the graph that he showed how he was able to grow his practice. And then George showed up. And George tells a story about, you know, Harvey coming to pick him up in an old roll with a cigar in his mouth. And George said, who is this guy, you know, but George was a fellowship trained as a surgeon out of Wake Forest. And it was and still is exceptionally gifted. He’s an extraordinarily really good cosmetic surgery better than Harvey who was a ballsy surgeon. And he would, he’s the one that we do, we do the mouth course, every who year at SPS, we’re doing it actually at the ASAP s this year. So, if you’ll be– So he takes a certain amount of surgical [inaudible 16:15] cuts around the mouth like that, but he was willing to do and nobody’s willing to do it, he ended up writing it up. And George was a better surgeon. Harvey’s patients, sometimes I didn’t really align myself with the way they look. Let’s put it that. And so, when I came down, both were very successful, they had the better surgeon Harvey’s patient first freestanding Surgical Clinic in the metro DC area. And I just sort of thought, I can work here, you know, Harvey, and I faced a couple of times where I actually yelled at him. And I, other than that, one time that I can remember, this is a long time ago, I don’t know that I ever had a cross word with Weston Poindexter or not, I don’t think any of us have. We have none at Stoke, in our practice, no surgeon has ever left. Or we have staff that have been there for 30 years. Me of me 35 staff. So, some people we rotate. I mean, some people move on, you know, the younger ones, that they go to nurses nursing school, or they go to medical school sometimes and but you know, it’s So, been the right choice for me. You know, I was always a team player in college, I wrote on Harvard’s PR team. And we were you know, we were IV champions a couple of times, and, and if crew doesn’t teach you anything, it teaches you how to participate with others and make folk go out and write and it’s who I would have turned out to be
Catherine Maley, MBA: Well, the one thing I noticed that you do differently than others is your all of the communication that you do is unusual for you to meet every week with each other and you just have such open communication and the staff is, when you’re there, you can feel it as a well running machine where there’s a lot of camaraderie. And that is unusual. Usually, there’s some backstabbing going on, there’s a lot of egos going askew. How do you– you must have the same values because I know that’s the underlying theme.
Robert Sigal, MD: Usually important. So, I want to say one thing before I get into that as well, I want to say one thing about you, before we get into that, and people that are listening to this, you know, Captain, you bring a tremendous wealth of experience to this universe, this business cosmetic surgery advisor. And so, you came to our practice, and I found you and you came to our practice. And when you come to our practice, you come with eyes that are not only a trained to the nuances of what works out there. But you see us from outside eyes, and you can see what only not only what does work, but you know what doesn’t work? In other words, like, I’ve been in the practice so long, I don’t see these things. It’s almost like if you were born with yellow sunglasses on, what would the world look like? Yeah, well, it was. No, it would look normal. Oh, right. Right. And so, if so and so the things that are in my office, they look sort of normal to me if I’m talking to you now, I don’t even know how different the practice is from what you see when you come. And so, when you go to other people’s practices, if they hire you like you like I like we did, you bring these really great new visions of the practice that we don’t even have like for example, you introduce the KPI thing to us. Remember, that KPI thing was really very, very helpful this key performance indicators It’s a way to get your staff involved in the management of the practice. We do it as part of our entire staff meets on Wednesday morning, from eight to nine, and we have a period of reconnecting and then we go over our KPIs, like, who’s doing what, how we’re doing, etc. So, I just wanted to say that it’s, it’s, the culture of the practice is somewhat, I can’t kind of see it. Now. Having said that, Doc, the business advisor, that I’ve mentioned before, he loves this topic of culture. And he generated a three hour long, three-to-three-hour long sessions, about three, four months ago, where he came in at five o’clock, and sat down with the staff with all of us and talked about culture, why our culture is different than for example, his universe is banking, a bank’s culture? Why is it different than a police force? Why is it different than a school system? And so, what do we value? And at the top of our, cultural safety, it wasn’t necessarily valued in the educational system, for example. And so, these are actually we can make these available on our YouTube on our site, our YouTube site, I think they’re very helpful for people to understand the nuances of their culture, the distinctions about what, how to think about culture. It is very important, and one thing is coming up right now, Catherine, it’s really very interesting, it’s gossip. And it’s gossip versus the value of long-term employees. Right. So, we are living in this question right now of what do we do with to long term employees have a history of being sort of gossipy and talking about others in an unconstructive way. But they’ve been with us for 10 years and longer, both of them. And they bring a certain amount of institutional knowledge that it’s going to be hard to get rid of, you know, so we’re struggling with it. And Jacques has been very helpful, because it’s the front of the younger guys want to get are more in favor of moving on. And the older guys, which I’m one more conflicted about it. So, how we’re resolving It is very important. And shock, having an outside business advisor that we all respect, is very important, when you have these larger groups like ours is with us, when I was president, up until a month ago, I would I would email talk to him once a week, asking for his thoughts on it. And I would always do what he said. But you know, it’s been you think about it differently. And just getting new ideas, like you bring to practices is very important. You can reject them. And sometimes they make you think of something and that’s more applicable or more efficient for your organization. So, get outside on it, learn things.
Catherine Maley, MBA: I’ll tell you what, what I’m learning, the deeper I get into this, as this commoditizes, as this industry commoditizes it will never fully because a surgeon is still a surgeon, and nobody else can do what you do. And however, as the patients are trying to choose, it’s going to be more and more important that you get that culture down, and that you’re all working together as a team. And so, when a patient walks into your practice, and they can feel it. And I don’t know if I’ve lived in Northern California too long, but I’m all feeling now, when I walked in, so easy for me to say, oh dear, we’ve got a problem here. You can feel the antagonists, the narrative, the [223:31] snarkiness of the staff and the partners that won’t get along, you can feel all of that. And I think that’s going to be your competitive edge when you can figure that out and have a well running practice with staff who want to be there with partners who want to lead not, they don’t want to manage they want to lead and lead managers management, I think it’s going to be more about who can play that game better than the other person because it’s not going to be about it could be about the surgery. It’s going to be about the business side of running a surgical practice professionally, emotionally, and with culture.
Robert Sigal, MD: What makes what that makes me think of because you’re absolutely right. What that makes me think of is, there have been periods in our office now for 25 years where it’s been more gossip, less gossip, more gossip, less gossip, real problems, less problems. And it’s very difficult in real time to figure out who the bad apple is making the apple cart. It’s very difficult. You walk into it, like you say, somewhere in Sausalito. And you can sense the snarkiness I’m pretty darn sure that the manager in that place is either an unaware of it or be who the source of it is. But I bet you if you spent a day there, you could figure it out. And so, by taking your ego out of the business and asking someone to come in like we’ve done multiple times, including you over the years, we’re able to you know get a better sense of who the problem is. And then you got to get rid of so one of the other shock jock isms is you know, hire slowly fire quickly. Fire with you know, generous severance, give them a monthly salary, whatever. But you got to you got to make a move and don’t be afraid to do it. Right, for sure. Yeah, there’s one of the benefits. As I’m thinking about, what we were going to talk about was that one of the benefits of having a four-surgeon group and being large at your practice is that you can, you can do certain things that you couldn’t do on your own, right. But you can bring in consultants and pay them to do this. Like, if it’s no four-surgeon pain to the bottom line, or we can rationalize if they want to only pay in a quarter, you know, but it’s very, like we have, we have our marketing person, we had an in-house videographer for a couple of years for a while, we have no ability to do things that you can’t do. Otherwise, it gives you more levers to pull, it gives you more tools to work with. And I appreciate that over the course of my career,
Catherine Maley, MBA: For sure. Alright, so the last thing about partnership, and then we’ll move on to the patient demographics. How are you handling generational differences between the older guys, the newer guy coming on? How’s that being handled?
Robert Sigal, MD: Or is that a good question? [inaudible 26:02] a good question. Well, because you know, the three of us, George, myself and Byron, have been partners for a long time. And Chris has been with us now for six, seven years. It’s almost like we are the three of us have a different generation than a doctor not. For example, I like to be called Rob. He likes to be called Dr. Nuts. And I understand I understand it, I mean it, and he should be, you know. But this is the two oldest mean, Weston, we work five days a week, Poindexter nuts work four days a week? Ah, yeah. And there’s a so I tried to let it sort of the consequences of that, from my, from my sense of things, you know, and as to whether it’s important or not enough to change behavior. I, you know, I don’t know, it’s not hurting the practice, per se, but it might hurt and, you know, an individual practice, which is the group’s practice, right. So, I don’t know that the generational changes, I mean, the millennial generation is now sort of the younger generation that’s coming into practice. They value things very differently than my baby boomer generation. And Western baby boomers. Well, Weston, had neck surgery. And it was back, I mean, a disk operated on and he was back at work in five days. Wow. And, you know, I mean, it was, he was so desperate to get back. I don’t know what it was fear based. I don’t know what it was about them, you know, I would have been out longer, you know, God. But honestly, you know what, I had an accident one time I crashed on a bike, I was training for a triathlon, and I was in the hospital with chest tube for a week. And I was I was back at work a couple of days after I got out of the hospital have broken shoulders and broken ribs and things. So yeah, I mean, I don’t know. It seems like there’s a whole cultural difference. They don’t, they don’t seem quite as concerned about money as they can support concerned about lifestyle. And I’m now at the point where I kind of don’t need the money anymore. But I still can’t give it up for the lifestyle. Although I did go down four days a week, last summer, just to try it, if you like, and it was kind of like, kind of nice. You know, the difference between five and two versus four and three, it really changes the stress level, when you come to that fourth day, you know, I’m going away for three days now versus the fifth day. I mean, yesterday, I did a six-hour surgery, and I need to go get a massage. So, stamina became a bigger issue in the older generation, I can keep doing this.
Catherine Maley, MBA: Right, let’s talk about the patients. And if we’re going to talk about generational differences, your patients, are they getting older with you? Or is this not bringing in the younger crowd? How’s that all working out with the patient demographics?
Robert Sigal, MD: Well, there’s a couple of things that brings to mind Michelle, what answer was yes, that my patients are a little bit older than when I was a younger surgeon. I do. Do probably 100 cases, maybe probably more than that a year. I didn’t do that early on. Doctor Nasus is more bodies and breasts, but our whole practice is more bodies and breasts, I think and perhaps skewing younger. And that’s because of social media. I think that you know, as that’s become more of a marketing force, right? I mean, the this I mean, you got your 5060-year-old women getting onto Instagram, but not as much as you know, the 20 your So, 25-year-old who’s living there, right, you know, Facebook? Yeah, I mean, I guess you know, what I’m finding Facebook useful is these groups that are like fish, there’s a Real Housewives of Loudon County or somewhere around near me and somehow, I have never been on the site. I don’t know it. But somehow, I’ve gotten mentioned amongst these women and that validates that validation, right. That’s anonymous validation is very important. So that that has led her practices to skews younger. There’s never been a big male part of our practice. I think that’s relatively useless. advertising. Barbie said a long time ago if you want to do faceless advertise for facelifts right, don’t advertise Juvéderm and think that that Jupiter patients going to have faceless someday? Well, right. I mean, so that’s my practice is I think overall skewing younger but not I’m my practice is getting older within the group practice queue and younger and that brings up injectables. You know, I know it’s something that we’ve wanted to talk about, and how do you integrate that. So, I love injectables, I think they’re really fun. I love using them in creative ways. I’m trying to always try new things. But within the context of makes sense. In my experience, we brought in our first nurse injector, probably four years ago, she’d been with us for many years and got her nurses degree while she worked for us nurse practitioner while she worked for us and Rick, great woman, and she’s we’ve helped build her practice. And we differentiated our practice from hers, because we were still doing injections was, we injected by the area and charged a fixed amount, guaranteeing enhancements if necessary, at no charge. She was charged by the unit and built her practice through Instagram. So really large, large practice. And I know we want to talk about regrets and successes. One of my major regrets is losing her. He was really a wonderful injector in my shoulders. And I and the reason we lost her was because it always gets back to your personal phone. My personal fault of not wanting to be thought badly of my manager, my office manager was concerned that I was micromanaging. And I didn’t want to be accused of it. And so, I just sort of laid back and let her do her thing. And she’s a wonderful manager, I think, well, there was there were gossipy problems festering in the office with our nurse injector. And I didn’t know about it. Now, I don’t know that I could have made a difference. But by the time I found out about it, I mean, there were tears shed, and it was just the whole drama thing. And, and I lost her. And so, it’s rough, you know, because I was probably 1215 years. But now we’ve got somebody else who was I’m really happy with and I’m happy to build her up too. And I’m not the President, but I don’t have to worry about it. But I can kind of be the elder kind of just come talk to me kind of going. But then you also don’t you don’t want that you want to empower your manager to like, you don’t want the staff coming to you. You want them coming to your manager and empower her. So, it’s tricky.
Catherine Maley, MBA: Regarding the patient procedures, are you jumping on bandwagon with BBL’s and all the new technologies happening, or how do you pronounce– How do you decide if you’re going to go with a trend or not or add a new procedure or not?
Robert Sigal, MD: Well, one of the things we do is we go around and we look at what to do, right? And so, we go to the meetings and I don’t even go to the meeting for the lectures anymore. I go to the meeting to go to the marketplace to see what who’s selling what, right. And if somebody one of my colleagues who I respect says, you got to check this out. I’ll check it out. If I see something in the marketplace, I like I’ll ask my colleagues, what do they think we’re slow to bring things on because these things are very expensive, and they’re hard to pay off and they generally have not been worthwhile. What has been worthwhile for us, I would say has been overall skin resurfacing lasers certainly gotten money back. The mirror dry, I believe has been helpful for us and made money on that over the years. That’s and we don’t do that. Obviously, our nurses do those things. DBL we’ve made money on hair lasers. We’ve made money on say what’s not been successful has been the diva in addition to the site time platform, the vaginal rejuvenation has not been helpful. There was another one that really–
Catherine Maley, MBA: You didn’t get [inaudible 34:08], did you get [inaudible] yet?
Robert Sigal, MD: No, we never did it. We never have done the big-time radio frequency things. I’ve gone and check them out. I’ve actually got another service surgeon office and watch them do these things that people come in, just generally unimaginative. The result I’m playing around with red lips now I think threadless are really interesting. Because there’s a certain it fills office a void right. In other words, there’s some people to come in, they’re just not they’re not going to have surgery and they don’t they still aren’t going to get it done. And they want something you know they want something they don’t want the downtime. So, like this may do that for me. Before I get to sort of a cheek lift, s lift, you know kind of thing so.
Catherine Maley, MBA: I can vouch for that, when I was probably 50, I was definitely– I’m not ready for surgery. I can’t believe I need a facelift but I need something and I was itching for that so are millions of other women and that’s why Lifestyle Lift took off because they 50, addressed an area of Where you’re not ready for the whole big deal, but you’re ready for something—
Robert Sigal, MD: Right, right, right. Well, so that makes me sick. I just saw a woman who came in to apply for a job I was operating. And I was just sort of talking to her I was operating and he had worked at a liposuction clinic in my area I’d never heard of, but like lifestyle, if what they had done was there was a businessman less, that was a surgeon who ends up advertising on television. And television is still a very powerful medium, but what you end up with is too many patients that can’t afford a lot, right? You know, and so you end up fake, you end up outsourcing these patients to surgeons that are generally lesser, you know, they’re just for whatever reason, they’re not committed, they’re not well trained, or not experienced whatever. And these things tend to collapse of their own weight, like lifestyle listed over time, these practices will go out of business, I’m sure I’ve seen too many times. Remember that? They were injecting the bile acids, there was a company that was doing that 1015 years ago, was in your area to these practices do that it was just over here on these coasts. It was the bile acids that cure that, that folic acid that they were injecting into fat right into the [inaudible 36:06] into the buying company that does it now. But that’s sort of the right way to do it, introduce it to your surgeon’s office, you read provider’s office, don’t Allegan go out and try to advertise this because it’s not for everybody, right?
Catherine Maley, MBA: They’ll spend a fortune on patient education. And that is not the way to go anymore. I mean, let the vendors do the patient education, but you have to educate them on you, you know, right, right time and the money and energy to, you know, help explain to ever the world why they need to do this particular procedure. Alright, so let’s Allegan talk about positioning, then, how are you? How do you differentiate yourself against all the other competitors? Because you’re in a super competitive area.
Robert Sigal, MD: Right? Oh, boy, I was thinking about how to answer this. And I think you don’t know what marketing really what’s going to hit, right. I mean, you, dude, you take care of your patients, as well as you possibly can you have your office be colinear on the culture, you have it be attractive, you have everything sort of look of a piece. And you know, the patients have now gone to see three surgeons and the third one. And if you have to convince them that you’re the one you’re done, it ain’t going to happen. It has to be subtler than that it has, we tend to be endorsed by the subtler things that people, you know, may see when they come in, or that they don’t even know they’re seeing the colors, surfaces, the smiles, the graphics, the tech that hopefully is not obtrusive, but the presence, and then we have to meet with a consultant before we see them. And that’s just our way of doing it. I’m sure other practices do it that way. I’m sure some don’t. But that patient coordinator, or we call them consultants, has the ability to endorse. And you patients’ do a great job. Catherine talking about your patient coordinators, are they the right ones for you, and then the skill set that they need, right? I would say that there’s the Beingness of the job. And then there’s the doing this of the job, right. And if you have to pick somebody to be your, your patient coordinator, you can’t teach beingness you can teach doing this, you actually, Catherine, can teach how to do it, right. But the friendly smile, the way you have, for example of making the patients’ person you’re with feel that they’re just the most important person in the room, if you’re patient coordinator doesn’t have that as part of their being, you can’t teach it. You can’t teach it. It’s like when it comes to the clothes. Right? When after I’ve been in and they’ve got to talk about it. Everybody’s got to have you know, she has to have listened so carefully that she understands what’s going to get to this person to Yes, it’s not necessarily about money. Sometimes it’s about fear. Sometimes it’s about who’s gonna take care of my kids. And sometimes it’s, you know, what am I going to look like? How long? How much time Can I take off is that, you know, or is inappropriate? Do they think that, you know, this is going to get my husband back, this is going to get my job promotion, you know, so all of these things are very important, and you can’t teach it. So those are the things I think that differentiate it. We’ve been around forever. You know, I’ve done this for a long time. So, one of the things that we wanted to do was put so many before and after’s that are really excellent up on our website, that when people go there, and everybody’s gonna go there, that, you know, they’re sort of, they get, you know, they’re overwhelmed. Now, one thing we haven’t done is differentiate results based on surgeon. That was a big issue, right? Like, are people gonna go to the website and see an awesome Weston result or they’re going to see Rob Siegel’s results? And honestly, it benefits the younger guys to ride the coattails of younger guys for a while and not have it known who did what? Right. So that’s a conscious thing that we did and other practices I know make different choices, but that’s what we did it work for us.
Catherine Maley, MBA: You have a ton of photos by the way. Well, you know what? That’s not a bad idea. Because if you’re a practice and you– do you market yourself as a practice or do each of you have your own Instagram accounts and websites?
Robert Sigal, MD: We have a practice Instagram account which is run by our social media person. And then we each have our own Instagram accounts just for a personal Instagram account. And then we have sort of a hybrid, which is our doctor Instagram account, which is on our practice Instagram account. And those are buttons underneath the name thing. And there you can find each of our takes on things. But it’s more about those videos, generally, those are things of us doing things in the operating rooms and talking about it. Individual results, we don’t really put them up there.
Catherine Maley, MBA: Your Instagram account, you don’t put your before and after photos?
Robert Sigal, MD: Individually, obviously, I’m not sure I wouldn’t be averse to it, but we generally don’t do it, we generally don’t do it
Catherine Maley, MBA: The patient should like to look at the photos, you know.
Robert Sigal, MD: They want to see it. And the reality is, Catherine, that us being together for so long in one building? Most things, like when you are a young surgeon, what’s the point really of having two offices five miles away? I mean, all you’re going to do is double your overhead. What’s the point you know, you’re traveling focus on one place, make one place work unless it’s so different over there that you got to go do it, you know, but things; in our place. It is working in this one building all these years, and going into George’s operating room and having Dr. Das come into Dr. Poindexter ‘s operating room and vice versa. And seeing how we do things; we are more alike in our surgical techniques and our results than any of us would be compared to kind of anybody else around us. Right. And so, there is a certain homogeneity to our results over time that I got this cool way of doing lower eyelid and made up, you know, so I show George now he loves it too. And you know, I got this new technique of doing something around the mouth, I show it to Byron, he likes that. And, you know, Byron shows me this thing where he’s doing it under the neck with the muscles, and I modify it. Now I do it every time. We call it face to face with it. But we’re still very similar in our results. And if we’re not similar in our results, and believe me, the nurses and post up, let us know that hey, seagull your bruising is much more significant to weapons, you got to go see what’s going on over there. Right? So, it makes sense for us to sort of put everything up as a group and not individualized based on our individual results.
Catherine Maley, MBA: Gotcha. And then regarding marketing, do you know what your marketing budget is? Is it a percentage of it? Does it flow depending on if you guys are busy, or you need to bring something up? One thing I do like about you when it comes to marketing, you’re very open minded about new ideas and trying new things. And you’ve done I think everything on Can you marketing in general, what has worked for you what and how much, how much resource Do you have to put into it to keep this boat afloat?
Robert Sigal, MD: So, a couple of things. One is 5% of the gross, just a round number to start from 5% from the gross. So, you ought to be thinking along those lines to start the older your practice, you can come down off of that, because you’re going to get more personal referrals. Once you develop a couple of years’ worth of track record, you can budget. And we know to the dollar, what we’re spending on our marketing, some things have worked on some things happen. And what years’ worth doesn’t what’s never worked for us is radio, we get enamored of the idea every once in a while. But this never works. Television is very expensive. If you can get on a show, maybe it helps a little bit, but not really. So, we tend to stay away from that. The print media as the backbone of our marketing has become less and less useful as print media becomes less and less useful. But on occasion for special events like open houses or seminars, and we’ll use print media and find it helpful along those lines. Now, it’s really you know, social media, its internet marketing, its websites, it’s how you get your website noticed. And its search engines, modification, and we’ve gone down multiple different roads to try to influence those things right now. We currently have in house marketing, we’ve gone out of house and the benefit of in houses, if somebody is really good and committed, they’re going to be dedicated to your practice, as opposed to an outside marketer who are going to have more resources to bear but aren’t only focused on you. They’re focused on you know, a bunch of other practices or other businesses. So, we’ve landed right now in house we had as I said, in house videographer so here we go back to find one because my sense was the video is becoming more important and then print up and still photos and I think my buddy Jerry dobro hadn’t gotten on the watch, you know that that was that’s brilliant. If you could get that you know, I don’t have to anymore. It’s gonna happen over Yeah, right. I mean, but at that point that it happened in in DC You know, that’s happening on the West Coast with a with a film industry. This doesn’t happen here. So, I don’t think that’s going to happen here. I was gonna say about–
Catherine Maley, MBA: I think you’re right about the video just to jump in because I firmly believe that everyone’s going to need a videographer on the payroll as this content creation has to bump up. Video is where it’s at, so I would suggest everybody get really comfortable being in front of the iPhone or an iPad or a camera, or video because that video is where it’s at.
Robert Sigal, MD: It’s so important. But you know, everybody’s got their iPhone, they can do their own video, and the videographer allows you to edit it and put it into a parcel to produce pieces, which are really cool. And the question is, is it really helpful? I remembered what I wanted to talk about? I think this is very important if you have a program called kiss, right? So, there’s, and I want you to talk about it for a minute. But you know, the whole other aspect of marketing is what you do with the patients that you already have. Right? Like not, the low hanging fruit are the ones that know you and come to you. It’s thought, you know, and they’re not expensive to get you don’t gotta get new ones. Right. But how do you keep them and we’re going to start with your kiss program. And we’ve done many things over the years. But I’ve always been intrigued by this. And it’s, you know, out of the box, kind of a thing. We don’t have to invent the wheel; you’ve got it for us. What have you found with it yet?
Catherine Maley, MBA: With kiss rewards club? I mean, my philosophy has always been since I got into this, I don’t understand why people or practices don’t spend more effort trying to get that patient a to say something to the stranger patient be like get their friends and family. Because our practices have always grown that way. It’s always been by word of mouth. And it always will be. I think what’s happened is SEO and social media has become such a frenzy. And it takes everyone off the game and says, oh my god, now we’ve got to write content, do videos be on Instagram, and I just never want to forget the fastest path the most direct will always be Susan talking to Karen, always. And I just think you should nurture that. And I will I always will. So, I will always have tools to help do that. Because that’s where all your leverage is.
Robert Sigal, MD: Then you say, Well, why haven’t surgeons adapted this or other practitioners adapted this? And there’s a certain arrogance to saying, Well, I shouldn’t have to do, that they should do it, you know, automatically because of that result, or I wouldn’t do that I wouldn’t go out and day, I wouldn’t talk about my results. And therefore, Why would anyone? Well, it’s a big world. And there’s a lot of people that want to talk about the results. And you don’t encourage them. But so, I think it’s a great idea, we’ll give it a shot and see what happens in the market and try it and see if it happens.
Catherine Maley, MBA: Okay. And let’s talk about the so, practice pitfalls. And like this part, like, you know, especially when it comes to staff, when you have that many staff and that many partners, you’ve got a lot of moving parts to this thing. How do you keep everybody on, you know, in the right seats, getting on the bus, all of that, and keeping that culture intact? Is there anything in particular that other than the meetings and the great communication, and you’re pretty transparent, by the way, the staff knows what it is you expected them and the KPIs, tell them what their numbers need to be. And so, I like that part a lot. You’re not hiding anything is like they’re very clear, you know, how you want to grow that practice. But is there anything in particular that you do to manage and or motivate the team?
Robert Sigal, MD: Oh, man, yes, there’s a lot of things. And there’s probably a whole bunch of things I don’t even know that we do, like you said that we do. These are the communication. So, if the KPIs have been helpful, along those lines, people know what’s expected. And you can watch people within your staff rise up to the challenge, take over team lead, and speak in public and watch them grow in their positions, and you want to reward that, and you will want it with no annual reviews, where you’re honest with them, you know, what are your strengths? What are your weaknesses? And you have to keep personal files on people, because, you know, this comes down to the time where you have to let someone go, you know, Harvey used to say that firing is irresponsible quitting, right, but it should have quit, but they did. So, if you got to fire and you better have some reasons, you know, over a period of time in their file, written up. And you have to talk to people, right? So, in our office manager, she’s, she’s never had really any formal training. So, we sent her down to the business management course at Disney for a week, and she raved about it. So personal development is very important. You know, our nurse anesthetist, they get a week off a year paid to go to go for learning and on top of their other vacation. So, if anybody wants to do any developmental course, we pay for it. And if people and people in the office see and staff go out and do these things, go out and do different career adjustments, go to nursing school, go to PA school, while they’re still working here, and we pay them and then they come back and get a raise. Right? So, it’s they see that and that person then tells the other person and if you’re a cultural outlier, and, you know, eventually you quit, it just doesn’t work, you know? Or the So, apples get polluted, and you can’t quite figure out what happened. And then you got the problem, right? That’s the one you don’t want. That’s a bad problem.
Catherine Maley, MBA: But I know you also do a killer Christmas party, but throughout the year, do you do anything as a team?
Robert Sigal, MD: Yeah, so we do. The KPIs have led to quarterly rewards and a bigger, a half year reward and then a very big year end reward. So, if you BGP give me Baker, more than 50% of the KPIs over the course of the year. Last year, we went to everybody to exceed Oh, and took them all out to dinner, gave a bunch of money. The other half year was taking them to Costco and given them a couple 100 bucks each and let them go shopping at Costco, we shut the Costco down. And we have the services come into the office and get massages. We have crepe trucks pull up and let people come and get free crepes. Yeah, I mean, you got to keep it fun. We have Pool Party every summer in my house and every Christmas. We have a party where we take over restaurant for the families and staff and then we have an in-office staff that Dr. Knox has run for the last number years. Oh man, this is this is just a hoot. Last year, we had each doctor pick a genre of music, I was rock and roll, Knots was wrapped, Poindexter was country-western, George was oldies. And we split the staff up into four and we each dressed up and then performed the song. I was Freddie Mercury and we did fat bottomed girls.
Catherine Maley, MBA: Did you videotape it, I hope?
Robert Sigal, MD: We did. Oh yeah, we got that. I don’t ever want to see that out in the public though. We got it, they gotta have fun. You know, I mean, it’s– I don’t know.
Catherine Maley, MBA: Did you notice the difference when you put those rewards in place and added the perky things like the fun things to do as a team? Did you notice a difference in the culture?
Robert Sigal, MD: Well, you’ll notice it with some and not with others, right? Like some people really, really love that idea. And some people just want to go home at the end of the day, you know, and just try and just go through the motions. So, it becomes obvious, it’s actually a good way to sort of weed them out. If they take it on. they own it. They really jumped in with to theater where they just, you know, kind of reluctant players
Catherine Maley, MBA: And didn’t make it comes up and regroup.
Robert Sigal, MD: I think it made a big difference in the overall place. Yeah. Big difference. Yeah, it’s interesting. Well, we get with Yes, I think it did make a difference in the numbers. And I think probably, we were up by 615 16%. year over year that we introduced that. So, I’m gonna have to attribute it to something right. And so, I’ll give it to that. Why not? Now, things over time, tend to continue, we have an expression conversation disappear. So, the KPI conversation sort of disappears over time, even though we insist on doing it every month on a Wednesday, it doesn’t become a strong motivator as it was when it first introduced, right. So, you have to come up with new and innovative ways all the time. And the issue is, as you get older in practice, like me and Weston is just like, you know, you’ve allowed the younger guys to have that enthusiasm. So, you were like, what else? Should I ask you kind of question? Ah, my wife, my wife had this really great question, which is, do you still love it? And what it made me think, right? I mean, what my what my, what it made me think of is that yes, but differently. When I first started, I was really enthusiastic. And I was passionate, and my love was almost fear based. Like if this doesn’t work, my kids are gonna die. You know, I mean, it was really at that existential level, right, I had to make it work. And I did things that, you know, I’ve thought of things on almost, feverish basis. And now, I don’t feel that way. I kind of got my goddess, you know what I mean? Like, I got the things I gotta have. And, and now I appreciate the practice in a far different way. Like, I think back this week, on the people that I saw, I did this tremendous difference if you’ve added ESL, you know, to transexuals that I got to talk to it really intimate levels and a young black woman from, from Milwaukee who came to– I did a rhinoplasty on and all these wonderful people that I get to know but you don’t get that in any other field. Right. And, and so I didn’t appreciate that so much, because I was frantic 25 years ago, but now I do appreciate it. So, I love it a different way.
Catherine Maley, MBA: Alright, so we’re getting ready to wrap up. Can you just tell me, do you have an exit strategy? Or where do you see you going in the future? And where’s the practice going? Because Pretty soon, there’s not going to be there’s not going to be an Austin Weston. There’s just, you know, there is–
Robert Sigal, MD: So that leads me to something else I wanted to– get to them that we’re going to talk about a little bit. When young people join an established practice or join the practice, they think that the buy in should be a lot less than it is they think that they’re buying a patient list. They’re not, they’re not buying a patient list. Harvey when he retired, his patients stopped coming. You know, they didn’t, they’re not buying that what they’re buying and buying into is the setup of the place. Right? And that’s what’s special about our places, we’ve evolved to set up all these systems, all this culture, all this, you know, knowledge that the institution has that one individual doesn’t have, and buying into that is expensive, right? And I didn’t see that when I was a younger surgeon. I was just, I was just pissed off, I had to pay so much. But as an older surgeon, I get it. Now. As far as exit strategy. I would like to see Austin was gone. I think Weston is close to the end. He’s gonna have to have another neck surgery, I’m afraid and I don’t know how that’s gonna go. I could retire tomorrow and be very happy. So, we what we do is we have a strategy session, outside of our normal conversations where we bring in a business person, and take a weekend, and sit down and try to flesh out how to do these things, right? Because here, we have to, again, take our ego out of it and recognize that we need outside eyes to help guide our conversation. Otherwise, it’s going to it’s going to go off track. And what we’ve learned is that there is a way to do this, given our different preferences for practice longevity, like I didn’t know the doctor Nazis really thinking of practicing for another 25 years. Right? He’s thinking now, maybe 10? Oh, you know, and Dr. Poindexter is thinking, you know, maybe 10. And I’m thinking, you know, I might cut back but I can do five or seven, you know, and at that point, maybe we bring somebody on maybe we come on nurse injector base, maybe we bring in a different skill set from another type of provider, not necessarily plastic surgeon. So, I think our options are there, the culture is still there. And I’d like to see it go on it. Because I think it’s a special thing that develops over time that you’d like to see keep going.
Catherine Maley, MBA: I’d like to find out, what would you suggest other surgeons if they were going to– if they want to up level? And what kind of skills do they need in today’s world to–?
Robert Sigal, MD: First they need a severe case of introspection. And they have to figure out what they don’t know, they don’t know, right? But you can divide the world up into four things, things that you know, you know, things that, you know, you don’t know, things that you don’t know that you actually do, though, which is a very interesting segment. And then the biggest segment by far, which is the things don’t, those don’t know, and the only way to find those things out is to go travel, and learn and see and read and, and immerse yourself in kind of in a humble way, which is done maybe when you’re younger, it’s a personality-based thing. I would say capitalism has a call you have to come to your office hasn’t called me I love it, when surgeons come pick me up, believe that we’re going to get more out of them come and visit us, they’re going to get covered to visit from us. So, everybody’s hearing this and wants to come personality-based. And you know, we’d love to talk to you.
Catherine Maley, MBA: Okay, well, okay, you heard him, give him a call.
Robert Sigal, MD: Yeah, absolutely. There’s a lot we could– we’ve been doing this for an hour. But there’s, you know, a day’s worth of stuff that we can talk about. And the only– that’s best done, like when you go to somebody’s office, or when they come, I’ve never really gone to anybody’s office comes to visit. But if they come to us to get four different opinions on how to do things, you see the setup, you’re going to see and feel like you said, whether it works or whether it doesn’t. And then you’ll be able to discern with your you cover eyes, what you know, is different that you can bring back to your practice some extent you have the ability to humility to come to that you’re gonna learn something, and it’s going to pay off I guarantee.
Catherine Maley, MBA: I think the biggest insight you said was introspection. And if you can get to know you, and what you’re made of, well, you’re going to find out anyway, running your own practice, you know, they always say, know yourself by either starting a business or having a health issue. And that’s when you get to know. And I think that’s true. So, like, for example, on things that I think are important in today’s world are leadership. And I think the surgeons have to get a lot better at who So, am I? What do I value? What’s our vision? And how do we keep the troops in line, but in a motivated, inspiring way, I think leader I’m going to start doing more on leadership because I think that’s missing.
Robert Sigal, MD: It’s interesting. I took a course on leadership one time, and you can sum it up in the title of the course, you can never not lead never not lead. Right. And, and it was, it was a couple of days seminar. But that was the bottom line. And of course, everything you do, everybody’s watching all the time. So, you, you got to be on it all the time. And you and you said this in some of your podcasts where, you know, if you come in in a coat tie, if you come in, you know that people are going to notice that and that’s going to set a certain tone, as opposed to coming in casually, you can then make a demand that your consultant that your practice managers show up looking appropriate, because you’re doing it, you know, so the leadership is very important.
Catherine Maley, MBA: Right, just give us one big mistake, they in your career that you made that would be helpful for others not to make?
Robert Sigal, MD: Oh God, it’s funny, I knew you’re gonna ask this. And I thought of it, I thought of it. And honestly, it’s too personal and I kind of don’t want to. I don’t want to put it out there just in case my kids– But you know, the business– put it in this domain, right? The business mistakes that I’ve made pale in comparison to personal mistakes that you make, okay? So be careful who you get involved with and if you don’t, and you can always make money, you know, but feelings can get hurt that can be taken back.
Catherine Maley, MBA: Okay. And then just lastly, is there a one-on-one piece of advice universally that would be helpful to everybody who’s trying to win at this game of plastic surgery and running a nice practice?
Robert Sigal, MD: Well, I would say this was the other part of the biggest mistake that I could say I think this is probably answers your question when you first come out and go where you want to live. And you’ll make it, you know, it’s no easier anywhere else. I think it is. But you know, there’s, there’s no plastic surgeon over there for a reason, you know, and there’s a lot of plastic surgeons in LA for a reason, you know, you’ll differentiate yourself and there’s a way to make a living, but you’re gonna at the end of the day, you’re gonna walk out the door and you’re going to be somewhere you better be where you’re like, you know, it’s going to be where your family makes sense or not where your friends are or not where you’re like the environment you like the weather like eatery, do that. It’s, it’s, I’m happy where I landed for a lot of different reasons. But I always like la when I trained out there, and I may end up have a daughter out there now. And I may end up there when it’s all over. So yeah, that would be a good one.
Catherine Maley, MBA: Okay, well, with that, we’re gonna wrap it up. Thank you so much, Dr. Sigal. So, everybody who wants to visit Dr. Sigal, he said you can visit just google austin-weston.com, you’ll find him online. And So, then we’re going to wrap it up. So, if you would, I’d love for you to subscribe to Beauty and the Biz. And if you would give me a review, that would be terrific because it helps me grow the message and reach more surgeons. And also, please pass this along to your colleagues and your staff and anybody who’s trying to understand how do you compete in a very competitive marketplace. And Dr. Sigal gave you a ton of tips on how to do that. And then if you’ve got any comments, I’d love your feedback as well just leave me a message on my website at catherinemaley.com. And with that, we’re gonna wrap it up. Thanks so much, we’ll talk again.